Gestational diabetes
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This document discusses gestational diabetes, including its definition, causes, importance of treatment, and treatment guidelines. Gestational diabetes is a form of diabetes that develops during pregnancy due to insulin resistance. Left untreated, it can lead to complications for both mother and baby like increased birth weight. Treatment aims to control blood sugar levels and can involve lifestyle changes as well as insulin if needed. Guidelines recommend screening and treatment according to established evidence-based protocols.
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Gestational diabetes
Gestational diabetes is a type of diabetes that develops during pregnancy in women who have never had diabetes before. It occurs in about 5% of all pregnancies. If not treated, gestational diabetes can cause health problems for both the mother and fetus, such as delivering a large baby. Risk factors include maternal age over 25, family history of diabetes, and belonging to certain ethnic groups. Women are screened for gestational diabetes between 24-28 weeks of pregnancy through a glucose challenge test and glucose tolerance test if needed. Treatment may involve diet, exercise, blood sugar monitoring, and possibly insulin.
Universal screening for gestational diabetes by DIPSI test by Dr.Preksha
pilot study, gestational diabetes mellitus, screening by post glucose blood sugar DIPSI test fetal and maternal outcome
Management of diabetes in pregnancy
This document discusses the management of diabetes in pregnancy. It defines diabetes and describes how pregnancy causes insulin resistance and increased insulin demands. It covers screening and diagnosis of gestational and pregestational diabetes. The effects of diabetes and pregnancy on each other are outlined. The goals of management are good glycemic control through diet, exercise, oral medications or insulin as needed. Fetal surveillance and maternal monitoring during pregnancy and delivery are also discussed.
Diabetes and Pregnancy
Diabetes during pregnancy can take three forms: gestational diabetes, pre-existing type 1 or 2 diabetes. All three increase risks like large baby size and c-section. High blood glucose in the womb can also cause problems for the baby after birth. Screening guidelines recommend testing women at high risk and sometimes all pregnant women. Treatment focuses on tight blood glucose control through diet, exercise and insulin if needed to improve outcomes for both mother and baby.
Diabetes in pregnancy
This document discusses diabetes in pregnancy. It provides information on the physiological changes in pregnancy that affect glucose metabolism and insulin resistance. It covers the classification, definition, and prevalence of gestational diabetes. Guidelines for screening and diagnosing gestational diabetes are presented. The document also discusses potential maternal and fetal/neonatal complications and provides recommendations for prepregnancy counseling, medical management including glycemic control targets, diet, exercise, and medication options, and obstetric management of diabetes in pregnancy.
Diabetes in Pregnancy
This document discusses gestational diabetes and its management. It defines gestational diabetes as glucose intolerance first recognized during pregnancy. It recommends screening all pregnant women with a 50-g glucose challenge test and diagnosing based on thresholds from a 75-g oral glucose tolerance test. Treatment aims to lower risks of macrosomia, cesarean sections, and monitor blood glucose with diet and exercise as first line therapies and sometimes insulin. Diet should provide 30-40% calories from complex carbohydrates and monitor weight gain based on pre-pregnancy BMI.
Gestational Diabetes Mellitus.pptx
Identifying women with GDM is important because appropriate therapy can decrease maternal and fetal morbidity .
Can prevent two generations from developing diabetes in the future.
Gestational Diabetes Mellitus
The document provides details about the panel moderator Dr. Kiran Pandey and her qualifications and experience in the field of obstetrics and gynecology. It lists her positions held including as head of the department of obstetrics and gynecology at GSVM Medical College in Kanpur, and her contributions to several national conferences and publications. It also outlines her areas of interest and awards received for her work.
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Gestational diabetes
Gestational diabetes is a type of diabetes that develops during pregnancy in women who have never had diabetes before. It occurs in about 5% of all pregnancies. If not treated, gestational diabetes can cause health problems for both the mother and fetus, such as delivering a large baby. Risk factors include maternal age over 25, family history of diabetes, and belonging to certain ethnic groups. Women are screened for gestational diabetes between 24-28 weeks of pregnancy through a glucose challenge test and glucose tolerance test if needed. Treatment may involve diet, exercise, blood sugar monitoring, and possibly insulin.
Universal screening for gestational diabetes by DIPSI test by Dr.Preksha
pilot study, gestational diabetes mellitus, screening by post glucose blood sugar DIPSI test fetal and maternal outcome
Management of diabetes in pregnancy
This document discusses the management of diabetes in pregnancy. It defines diabetes and describes how pregnancy causes insulin resistance and increased insulin demands. It covers screening and diagnosis of gestational and pregestational diabetes. The effects of diabetes and pregnancy on each other are outlined. The goals of management are good glycemic control through diet, exercise, oral medications or insulin as needed. Fetal surveillance and maternal monitoring during pregnancy and delivery are also discussed.
Diabetes and Pregnancy
Diabetes during pregnancy can take three forms: gestational diabetes, pre-existing type 1 or 2 diabetes. All three increase risks like large baby size and c-section. High blood glucose in the womb can also cause problems for the baby after birth. Screening guidelines recommend testing women at high risk and sometimes all pregnant women. Treatment focuses on tight blood glucose control through diet, exercise and insulin if needed to improve outcomes for both mother and baby.
Diabetes in pregnancy
This document discusses diabetes in pregnancy. It provides information on the physiological changes in pregnancy that affect glucose metabolism and insulin resistance. It covers the classification, definition, and prevalence of gestational diabetes. Guidelines for screening and diagnosing gestational diabetes are presented. The document also discusses potential maternal and fetal/neonatal complications and provides recommendations for prepregnancy counseling, medical management including glycemic control targets, diet, exercise, and medication options, and obstetric management of diabetes in pregnancy.
Diabetes in Pregnancy
This document discusses gestational diabetes and its management. It defines gestational diabetes as glucose intolerance first recognized during pregnancy. It recommends screening all pregnant women with a 50-g glucose challenge test and diagnosing based on thresholds from a 75-g oral glucose tolerance test. Treatment aims to lower risks of macrosomia, cesarean sections, and monitor blood glucose with diet and exercise as first line therapies and sometimes insulin. Diet should provide 30-40% calories from complex carbohydrates and monitor weight gain based on pre-pregnancy BMI.
Gestational Diabetes Mellitus.pptx
Identifying women with GDM is important because appropriate therapy can decrease maternal and fetal morbidity .
Can prevent two generations from developing diabetes in the future.
Gestational Diabetes Mellitus
The document provides details about the panel moderator Dr. Kiran Pandey and her qualifications and experience in the field of obstetrics and gynecology. It lists her positions held including as head of the department of obstetrics and gynecology at GSVM Medical College in Kanpur, and her contributions to several national conferences and publications. It also outlines her areas of interest and awards received for her work.
GESTATIONAL DIABETES MELLITUS SCREENING
This document discusses screening for gestational diabetes mellitus (GDM). It defines GDM and explains that pregnancy increases insulin resistance. There are two approaches to screening - a single step 75g oral glucose tolerance test (OGTT), or a two step approach using a 50g glucose challenge test followed by a 100g OGTT if thresholds are met. Threshold values for diagnosing GDM on OGTT tests are provided. The Seshiah test, recommended in India, performs a 75g OGTT in the non-fasting state, diagnosing GDM if the 2hr value is ≥140mg/dL.
Diabetes Mellitus in pregnancy " Gestational diabetes mellitus''
This document discusses a case of gestational diabetes in a 24-year-old pregnant woman. It defines gestational diabetes as glucose intolerance that develops during pregnancy. Risk factors, diagnostic tests such as OGTT, management including diet, exercise and insulin therapy if needed, and maternal and fetal complications of gestational diabetes are described. The goals of antepartum care including fetal surveillance to minimize risks are also mentioned.
Diabetes in pregnancy
The document summarizes the physiological changes in glucose metabolism during pregnancy including increased insulin resistance, higher fasting and postprandial blood glucose, and doubled insulin production. It also discusses the diagnosis and management of gestational diabetes and diabetes in pregnancy, including the effects on the mother and fetus as well as treatment approaches involving diet, insulin, monitoring, and delivery.
Gestational diabetes mellitus
The document discusses gestational diabetes mellitus (GDM). It begins with physiological changes in pregnancy that increase insulin resistance and glucose intolerance. It then defines GDM, discusses prevalence, screening methods, diagnosis, medical and obstetric management, and controversies around screening. Key points include that GDM is associated with adverse maternal and neonatal outcomes. Screening methods include fasting blood glucose and glucose challenge tests. Treatment involves diet, exercise, and potentially insulin or oral hypoglycemic drugs. The goal of management is to maintain euglycemia and prevent macrosomia and other complications.
Hypertension in pregnancy
Chronic hypertension is one of the most common medical complications in pregnancy. It increases the risks of superimposed preeclampsia, placental abruption, low birth weight, preterm delivery, and perinatal mortality. Management involves lifestyle modifications, monitoring, and antihypertensive medications. First-line medications include methyldopa, labetalol, and hydrochlorothiazide, though diuretics are avoided after 20 weeks due to risks of decreasing plasma volume. While controlling blood pressure benefits mothers, aggressive treatment risks decreasing uteroplacental perfusion and worsening outcomes for fetuses. Thus, treatment of mild to moderate hypertension during pregnancy remains debated.
Gestational Diabetes Mellitus
Gestational diabetes mellitus (GDM) is a type of diabetes that develops during pregnancy. Rates of GDM are estimated to be 10-14.3% in India, higher than Western countries. Women with GDM and their offspring have an increased risk of developing type 2 diabetes later in life. Treatment for GDM involves medical nutrition therapy, physical activity, blood sugar monitoring, and potentially metformin or insulin therapy if blood sugar levels remain high. Proper management of GDM can help prevent complications for both mother and baby during pregnancy and reduce long-term health risks.
Case presntation -Anamia in Pregnancy-Case Review
Regina Anthony, a 30-year-old pregnant woman at 27 weeks gestation, presented with dizziness, generalized body weakness, swollen limbs, and paleness for 3 months. On examination, she appeared pale and sickly. Laboratory results showed severe anemia with a hemoglobin of 7.1 g/dL. She was diagnosed with severe anemia in pregnancy secondary to HIV infection. She received blood transfusions, antiretroviral therapy, and treatment for anemia. Anemia is common in pregnancy and can be caused by iron deficiency, infection, or other nutritional deficiencies. It poses serious risks if left untreated.
diabetes in pregnancy
1) Gestational diabetes occurs in 3-5% of pregnancies and 90% of women with abnormal glucose tolerance have gestational diabetes. Approximately 50% will later develop type 2 diabetes.
2) Gestational diabetes increases risks for both mother and fetus, including preeclampsia for the mother and fetal macrosomia, hypoglycemia and birth trauma for the fetus.
3) Gestational diabetes is managed primarily through diet and exercise, with insulin therapy if needed to control blood glucose levels and minimize complications. Women with gestational diabetes have increased monitoring during and after pregnancy.
Gestational Diabetes
1. The document discusses the clinical management of diabetes during pregnancy, including screening, diagnosis, and treatment of gestational and pregestational diabetes.
2. It outlines the risks of hyperglycemia for both mother and fetus, including fetal macrosomia, complications during delivery, and long-term risks like childhood obesity.
3. The management of diabetes during pregnancy involves tight glycemic control through diet, glucose monitoring, and insulin when needed to improve outcomes for both mother and baby.
Preeclampsia
This document discusses hypertension in pregnancy and preeclampsia. It begins by outlining normal blood pressure changes during pregnancy, then defines pregnancy-induced hypertension and chronic hypertension. It distinguishes between gestational hypertension, preeclampsia, and eclampsia. Preeclampsia is defined as new onset hypertension and proteinuria after 20 weeks of gestation. Risk factors, incidence rates, causes, pathophysiology, complications, classification, diagnosis, and management of preeclampsia are then summarized. Indications for delivery are outlined for both mild and severe preeclampsia cases based on maternal and fetal stability and gestational age.
Diabetes and macrosomia
This document discusses several studies related to gestational diabetes and macrosomia. The first study found that maternal BMI had a greater influence on the development of large for gestational age (LGA) babies than glucose control. A second study identified that maternal BMI and LGA in a previous pregnancy most influenced fetal growth in the late second and early third trimesters, while maternal glycemia predominantly impacted growth later in the third trimester. A third study examined the degree of glucose control needed in women with type 1 diabetes to achieve normal fetal growth and neonatal proportions.
pg case presentation , obstetrics
Gestational diabetes mellitus (GDM) is diabetes that develops during pregnancy and can cause complications for both the mother and baby if not properly managed. The case presentation describes a 30-year-old pregnant woman with decreased fetal movement at 36 weeks of pregnancy who has a history of GDM. Management of GDM focuses on tight glycemic control through diet, exercise, blood glucose monitoring and possibly insulin to prevent complications like premature delivery, macrosomia, hypoglycemia and jaundice in the baby. Both mother and baby require close monitoring during and after pregnancy.
Hyperthyroidism During pregnancy
The document summarizes physiological changes in thyroid function during pregnancy and management of hyperthyroidism. Key points:
1) Thyroid binding globulin, TT4, and TT3 levels increase during pregnancy to compensate for decreased FT4 and FT3. TSH decreases in the first trimester and increases in the second and third trimesters.
2) Hyperthyroidism in pregnancy is usually caused by Graves' disease and can cause complications if unmanaged. Treatment involves antithyroid medications like PTU and carbimazole.
3) Treatment aims to control hyperthyroidism rapidly and maintain euthyroidism with the lowest effective drug dose to avoid fetal hypothyroidism or goiter
Gdm ho presentation
Gestational diabetes is a form of diabetes that develops during pregnancy and usually resolves after giving birth. It occurs when hormones produced during pregnancy interfere with the mother's body's ability to produce and use insulin properly. This can cause high blood glucose levels. Left untreated, gestational diabetes can increase the risk of complications for both mother and baby, such as preeclampsia in the mother, and macrosomia, shoulder dystocia, and jaundice in the baby. It is diagnosed through a glucose tolerance test between 24-28 weeks of gestation. Treatment may involve lifestyle modifications like diet and exercise or insulin therapy if needed. Close monitoring during pregnancy and screening for diabetes after pregnancy is important.
Anemia in pregnancy safemotherhood
This document discusses anemia in pregnancy. It defines anemia and notes that about half of all pregnant women worldwide are anemic. Causes of anemia in pregnancy include iron deficiency, other nutritional deficiencies, infection, and blood loss. Untreated anemia can lead to complications for both mother and baby like preterm delivery and low birth weight. Screening and treatment of anemia is important. Oral iron supplementation is usually first line treatment for iron deficiency anemia in pregnancy.
Gestational Diabetes Mellitus (GDM)
This document discusses gestational diabetes mellitus (GDM), including its definition, epidemiology, etiology, pathophysiology, risk factors, maternal and fetal complications, screening, management, and the role of exercise and physiotherapy. Some key points:
- GDM is defined as glucose intolerance that begins or is first recognized during pregnancy and puts both mother and child at risk for developing diabetes later in life.
- Risk factors include family history of diabetes, previous large baby, past pregnancy loss, age over 30, obesity.
- Increased hormones during pregnancy cause insulin resistance, leading to high blood glucose levels if not managed.
- Screening usually occurs between 24-28 weeks with an oral glucose tolerance test
Eclampsia preeclampsia
1) Hypertensive disorders complicate 5-10% of pregnancies and are a leading cause of maternal mortality. They include gestational hypertension, preeclampsia, eclampsia, and chronic hypertension.
2) Preeclampsia is defined as new hypertension and proteinuria after 20 weeks of gestation. It is caused by abnormal placentation leading to endothelial dysfunction and multi-organ involvement.
3) Women with signs of severe preeclampsia such as severe headaches, visual disturbances, abdominal pain, thrombocytopenia, or impaired liver or kidney function require delivery, usually between 34-37 weeks of gestation. Strict maternal and fetal monitoring is necessary for management.
Gestational Diabetes by Dr Shahjada Selim
Gestational diabetes mellitus (GDM) is a type of diabetes that develops during pregnancy and usually resolves after giving birth. However, women with GDM have an increased risk of developing type 2 diabetes later in life. The document discusses the pathophysiology, risk factors, screening and diagnostic criteria, management, and long term risks of GDM. Key points include that GDM results from insufficient insulin production in the face of insulin resistance during pregnancy, and is diagnosed through an oral glucose tolerance test between 24-28 weeks of gestation. Treatment involves medical nutrition therapy, exercise, blood glucose monitoring, and possibly insulin to control blood sugar levels and minimize risks.
Diabetes in pregnancy
This document discusses gestational diabetes mellitus (GDM). It begins by defining GDM as an endocrine disease involving faulty carbohydrate metabolism that complicates 3-5% of pregnancies. The document then discusses the pathophysiology of GDM, screening and diagnostic methods including oral glucose tolerance tests, maternal and fetal complications, and management approaches including careful antenatal supervision and control of blood sugar levels. Key goals of management are finding the optimal time and method of delivery and arranging newborn care.
Epilepsy in pregnancy
Seizures during pregnancy can cause: Slowing of the fetal heart rate. Decreased oxygen to the fetus. Fetal injury, premature separation of the placenta from the uterus (placental abruption) or miscarriage due to trauma, such as a fall, during a seizure
Gestational diabetes mellitus
Gestational diabetes mellitus (GDM) is glucose intolerance that develops during pregnancy and accounts for 90% of cases of diabetes in pregnancy. Risk factors include age over 25, BMI over 25, family history of diabetes, and certain ethnic backgrounds. GDM is caused by insulin resistance during pregnancy and can lead to complications for both mother and baby if not well-controlled such as preeclampsia, macrosomia, and neonatal hypoglycemia. Diagnosis involves screening all pregnant women between 24-28 weeks gestation with a glucose challenge test followed by a 3-hour 100g oral glucose tolerance test for those who fail. Management focuses on tight glycemic control through diet, exercise, glucose monitoring, and possibly insulin
GDM
This document discusses diabetes mellitus in pregnancy. It defines diabetes and classifies its types. Gestational diabetes is the most common type seen in pregnancy, accounting for 90% of diabetes cases. Pregnancy increases the risk of developing diabetes due to placental hormones that cause insulin resistance. Screening and management of diabetes in pregnancy is important to prevent complications for both mother and fetus such as macrosomia, shoulder dystocia, and preeclampsia. Treatment involves diet, exercise, blood sugar monitoring, and possibly insulin therapy.
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GESTATIONAL DIABETES MELLITUS SCREENING
This document discusses screening for gestational diabetes mellitus (GDM). It defines GDM and explains that pregnancy increases insulin resistance. There are two approaches to screening - a single step 75g oral glucose tolerance test (OGTT), or a two step approach using a 50g glucose challenge test followed by a 100g OGTT if thresholds are met. Threshold values for diagnosing GDM on OGTT tests are provided. The Seshiah test, recommended in India, performs a 75g OGTT in the non-fasting state, diagnosing GDM if the 2hr value is ≥140mg/dL.
Diabetes Mellitus in pregnancy " Gestational diabetes mellitus''
This document discusses a case of gestational diabetes in a 24-year-old pregnant woman. It defines gestational diabetes as glucose intolerance that develops during pregnancy. Risk factors, diagnostic tests such as OGTT, management including diet, exercise and insulin therapy if needed, and maternal and fetal complications of gestational diabetes are described. The goals of antepartum care including fetal surveillance to minimize risks are also mentioned.
Diabetes in pregnancy
The document summarizes the physiological changes in glucose metabolism during pregnancy including increased insulin resistance, higher fasting and postprandial blood glucose, and doubled insulin production. It also discusses the diagnosis and management of gestational diabetes and diabetes in pregnancy, including the effects on the mother and fetus as well as treatment approaches involving diet, insulin, monitoring, and delivery.
Gestational diabetes mellitus
The document discusses gestational diabetes mellitus (GDM). It begins with physiological changes in pregnancy that increase insulin resistance and glucose intolerance. It then defines GDM, discusses prevalence, screening methods, diagnosis, medical and obstetric management, and controversies around screening. Key points include that GDM is associated with adverse maternal and neonatal outcomes. Screening methods include fasting blood glucose and glucose challenge tests. Treatment involves diet, exercise, and potentially insulin or oral hypoglycemic drugs. The goal of management is to maintain euglycemia and prevent macrosomia and other complications.
Hypertension in pregnancy
Chronic hypertension is one of the most common medical complications in pregnancy. It increases the risks of superimposed preeclampsia, placental abruption, low birth weight, preterm delivery, and perinatal mortality. Management involves lifestyle modifications, monitoring, and antihypertensive medications. First-line medications include methyldopa, labetalol, and hydrochlorothiazide, though diuretics are avoided after 20 weeks due to risks of decreasing plasma volume. While controlling blood pressure benefits mothers, aggressive treatment risks decreasing uteroplacental perfusion and worsening outcomes for fetuses. Thus, treatment of mild to moderate hypertension during pregnancy remains debated.
Gestational Diabetes Mellitus
Gestational diabetes mellitus (GDM) is a type of diabetes that develops during pregnancy. Rates of GDM are estimated to be 10-14.3% in India, higher than Western countries. Women with GDM and their offspring have an increased risk of developing type 2 diabetes later in life. Treatment for GDM involves medical nutrition therapy, physical activity, blood sugar monitoring, and potentially metformin or insulin therapy if blood sugar levels remain high. Proper management of GDM can help prevent complications for both mother and baby during pregnancy and reduce long-term health risks.
Case presntation -Anamia in Pregnancy-Case Review
Regina Anthony, a 30-year-old pregnant woman at 27 weeks gestation, presented with dizziness, generalized body weakness, swollen limbs, and paleness for 3 months. On examination, she appeared pale and sickly. Laboratory results showed severe anemia with a hemoglobin of 7.1 g/dL. She was diagnosed with severe anemia in pregnancy secondary to HIV infection. She received blood transfusions, antiretroviral therapy, and treatment for anemia. Anemia is common in pregnancy and can be caused by iron deficiency, infection, or other nutritional deficiencies. It poses serious risks if left untreated.
diabetes in pregnancy
1) Gestational diabetes occurs in 3-5% of pregnancies and 90% of women with abnormal glucose tolerance have gestational diabetes. Approximately 50% will later develop type 2 diabetes.
2) Gestational diabetes increases risks for both mother and fetus, including preeclampsia for the mother and fetal macrosomia, hypoglycemia and birth trauma for the fetus.
3) Gestational diabetes is managed primarily through diet and exercise, with insulin therapy if needed to control blood glucose levels and minimize complications. Women with gestational diabetes have increased monitoring during and after pregnancy.
Gestational Diabetes
1. The document discusses the clinical management of diabetes during pregnancy, including screening, diagnosis, and treatment of gestational and pregestational diabetes.
2. It outlines the risks of hyperglycemia for both mother and fetus, including fetal macrosomia, complications during delivery, and long-term risks like childhood obesity.
3. The management of diabetes during pregnancy involves tight glycemic control through diet, glucose monitoring, and insulin when needed to improve outcomes for both mother and baby.
Preeclampsia
This document discusses hypertension in pregnancy and preeclampsia. It begins by outlining normal blood pressure changes during pregnancy, then defines pregnancy-induced hypertension and chronic hypertension. It distinguishes between gestational hypertension, preeclampsia, and eclampsia. Preeclampsia is defined as new onset hypertension and proteinuria after 20 weeks of gestation. Risk factors, incidence rates, causes, pathophysiology, complications, classification, diagnosis, and management of preeclampsia are then summarized. Indications for delivery are outlined for both mild and severe preeclampsia cases based on maternal and fetal stability and gestational age.
Diabetes and macrosomia
This document discusses several studies related to gestational diabetes and macrosomia. The first study found that maternal BMI had a greater influence on the development of large for gestational age (LGA) babies than glucose control. A second study identified that maternal BMI and LGA in a previous pregnancy most influenced fetal growth in the late second and early third trimesters, while maternal glycemia predominantly impacted growth later in the third trimester. A third study examined the degree of glucose control needed in women with type 1 diabetes to achieve normal fetal growth and neonatal proportions.
pg case presentation , obstetrics
Gestational diabetes mellitus (GDM) is diabetes that develops during pregnancy and can cause complications for both the mother and baby if not properly managed. The case presentation describes a 30-year-old pregnant woman with decreased fetal movement at 36 weeks of pregnancy who has a history of GDM. Management of GDM focuses on tight glycemic control through diet, exercise, blood glucose monitoring and possibly insulin to prevent complications like premature delivery, macrosomia, hypoglycemia and jaundice in the baby. Both mother and baby require close monitoring during and after pregnancy.
Hyperthyroidism During pregnancy
The document summarizes physiological changes in thyroid function during pregnancy and management of hyperthyroidism. Key points:
1) Thyroid binding globulin, TT4, and TT3 levels increase during pregnancy to compensate for decreased FT4 and FT3. TSH decreases in the first trimester and increases in the second and third trimesters.
2) Hyperthyroidism in pregnancy is usually caused by Graves' disease and can cause complications if unmanaged. Treatment involves antithyroid medications like PTU and carbimazole.
3) Treatment aims to control hyperthyroidism rapidly and maintain euthyroidism with the lowest effective drug dose to avoid fetal hypothyroidism or goiter
Gdm ho presentation
Gestational diabetes is a form of diabetes that develops during pregnancy and usually resolves after giving birth. It occurs when hormones produced during pregnancy interfere with the mother's body's ability to produce and use insulin properly. This can cause high blood glucose levels. Left untreated, gestational diabetes can increase the risk of complications for both mother and baby, such as preeclampsia in the mother, and macrosomia, shoulder dystocia, and jaundice in the baby. It is diagnosed through a glucose tolerance test between 24-28 weeks of gestation. Treatment may involve lifestyle modifications like diet and exercise or insulin therapy if needed. Close monitoring during pregnancy and screening for diabetes after pregnancy is important.
Anemia in pregnancy safemotherhood
This document discusses anemia in pregnancy. It defines anemia and notes that about half of all pregnant women worldwide are anemic. Causes of anemia in pregnancy include iron deficiency, other nutritional deficiencies, infection, and blood loss. Untreated anemia can lead to complications for both mother and baby like preterm delivery and low birth weight. Screening and treatment of anemia is important. Oral iron supplementation is usually first line treatment for iron deficiency anemia in pregnancy.
Gestational Diabetes Mellitus (GDM)
This document discusses gestational diabetes mellitus (GDM), including its definition, epidemiology, etiology, pathophysiology, risk factors, maternal and fetal complications, screening, management, and the role of exercise and physiotherapy. Some key points:
- GDM is defined as glucose intolerance that begins or is first recognized during pregnancy and puts both mother and child at risk for developing diabetes later in life.
- Risk factors include family history of diabetes, previous large baby, past pregnancy loss, age over 30, obesity.
- Increased hormones during pregnancy cause insulin resistance, leading to high blood glucose levels if not managed.
- Screening usually occurs between 24-28 weeks with an oral glucose tolerance test
Eclampsia preeclampsia
1) Hypertensive disorders complicate 5-10% of pregnancies and are a leading cause of maternal mortality. They include gestational hypertension, preeclampsia, eclampsia, and chronic hypertension.
2) Preeclampsia is defined as new hypertension and proteinuria after 20 weeks of gestation. It is caused by abnormal placentation leading to endothelial dysfunction and multi-organ involvement.
3) Women with signs of severe preeclampsia such as severe headaches, visual disturbances, abdominal pain, thrombocytopenia, or impaired liver or kidney function require delivery, usually between 34-37 weeks of gestation. Strict maternal and fetal monitoring is necessary for management.
Gestational Diabetes by Dr Shahjada Selim
Gestational diabetes mellitus (GDM) is a type of diabetes that develops during pregnancy and usually resolves after giving birth. However, women with GDM have an increased risk of developing type 2 diabetes later in life. The document discusses the pathophysiology, risk factors, screening and diagnostic criteria, management, and long term risks of GDM. Key points include that GDM results from insufficient insulin production in the face of insulin resistance during pregnancy, and is diagnosed through an oral glucose tolerance test between 24-28 weeks of gestation. Treatment involves medical nutrition therapy, exercise, blood glucose monitoring, and possibly insulin to control blood sugar levels and minimize risks.
Diabetes in pregnancy
This document discusses gestational diabetes mellitus (GDM). It begins by defining GDM as an endocrine disease involving faulty carbohydrate metabolism that complicates 3-5% of pregnancies. The document then discusses the pathophysiology of GDM, screening and diagnostic methods including oral glucose tolerance tests, maternal and fetal complications, and management approaches including careful antenatal supervision and control of blood sugar levels. Key goals of management are finding the optimal time and method of delivery and arranging newborn care.
Epilepsy in pregnancy
Seizures during pregnancy can cause: Slowing of the fetal heart rate. Decreased oxygen to the fetus. Fetal injury, premature separation of the placenta from the uterus (placental abruption) or miscarriage due to trauma, such as a fall, during a seizure
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Diabetes Mellitus in pregnancy " Gestational diabetes mellitus''
Diabetes Mellitus in pregnancy " Gestational diabetes mellitus''
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Gestational diabetes mellitus
Gestational diabetes mellitus (GDM) is glucose intolerance that develops during pregnancy and accounts for 90% of cases of diabetes in pregnancy. Risk factors include age over 25, BMI over 25, family history of diabetes, and certain ethnic backgrounds. GDM is caused by insulin resistance during pregnancy and can lead to complications for both mother and baby if not well-controlled such as preeclampsia, macrosomia, and neonatal hypoglycemia. Diagnosis involves screening all pregnant women between 24-28 weeks gestation with a glucose challenge test followed by a 3-hour 100g oral glucose tolerance test for those who fail. Management focuses on tight glycemic control through diet, exercise, glucose monitoring, and possibly insulin
GDM
This document discusses diabetes mellitus in pregnancy. It defines diabetes and classifies its types. Gestational diabetes is the most common type seen in pregnancy, accounting for 90% of diabetes cases. Pregnancy increases the risk of developing diabetes due to placental hormones that cause insulin resistance. Screening and management of diabetes in pregnancy is important to prevent complications for both mother and fetus such as macrosomia, shoulder dystocia, and preeclampsia. Treatment involves diet, exercise, blood sugar monitoring, and possibly insulin therapy.
Gestational diabetes
This document discusses diabetes during pregnancy, including gestational diabetes and prediabetes. It provides statistics on the prevalence of different types of diabetes during pregnancy. Type 2 diabetes in pregnancy has a better prognosis than type 1 diabetes, with fewer complications. The document also discusses risk factors, screening, and management of gestational diabetes and prediabetes during and after pregnancy. It provides guidelines for screening and outlines the one-step and two-step approaches to screening and diagnosing gestational diabetes.
Diabetes In Pregnancy
A comprehensive guide to the management of hyperglycaemia in pregnancy aimed at the primary care physician and based on latest evidenced based criteria. Includes information from latest studies such as HAPO study and ACHOIS, and involves guidelines from the IADPSG, ADA, WHO and Malaysia.
Gestational Diabetes.
This document provides information about gestational diabetes mellitus (GDM), a condition where women without a previous history of diabetes experience high blood sugar levels during pregnancy. The key points are:
- GDM occurs in approximately 5% of pregnancies and can cause health issues for both the mother and baby if not treated.
- Risk factors include age over 25, family history of diabetes, and certain ethnic backgrounds.
- Screening usually takes place between 24-28 weeks of pregnancy with a glucose test.
- Treatment involves diet, exercise, and possibly insulin therapy to control blood sugar levels and minimize health risks.
- Both mother and baby must be monitored during and after pregnancy due to risks like developing type 2 diabetes
GESTATIONAL DIABETES
EASY TO FOLLOW POWERPOINT PRESENTATION ON GDM USEFUL FOR HEALTH CARE PROVIDERS AND ALL WOMEN OF REPRODUCTIVE AGE GROUP
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This document provides an overview of diabetes in pregnancy. It defines diabetes mellitus and describes the main types: type 1, type 2, and gestational diabetes. Risk factors, screening, and diagnostic criteria for gestational diabetes are covered. The document also discusses complications of diabetes in pregnancy for both mother and baby, as well as management through medical nutrition therapy, exercise, medication and insulin. Postpartum care is also summarized.
gdm (1).pptx
Gestational diabetes mellitus (GDM) is glucose intolerance that begins or is first diagnosed during pregnancy. The risks associated with GDM are similar to those with pregestational diabetes. Screening and diagnosis typically involves a 75g oral glucose tolerance test. Management of GDM focuses on achieving metabolic control through diet, exercise, insulin or oral hypoglycemic agents. Fetal surveillance is important during pregnancy and delivery should be monitored closely due to risks of complications. Postpartum care involves glucose monitoring and determining if diabetes persists after delivery.
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This document discusses gestational diabetes, including its definition, epidemiology, consequences for both mother and fetus, screening recommendations, management, and controversies around diagnostic criteria. Some key points:
- Gestational diabetes is defined as carbohydrate intolerance first recognized during pregnancy and can include undiagnosed preexisting diabetes.
- It affects 2-9% of pregnancies and screening is recommended for at-risk women between 24-28 weeks using a 75g oral glucose tolerance test.
- Risks for the fetus include macrosomia, jaundice, and hypoglycemia. Risks for the mother include preeclampsia, infections, and long-term risk of type 2 diabetes.
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gdm (1).pptx
This document provides information on gestational diabetes mellitus (GDM), including its definition, risk factors, effects during pregnancy, screening and diagnosis guidelines, management, and fetal surveillance. GDM is glucose intolerance that begins during pregnancy and usually resolves after delivery. It increases risks for both mother and baby, so screening and treatment are important. Guidelines recommend screening all pregnant women for GDM, and treating it with medical nutrition therapy, exercise and possibly insulin to control blood glucose levels if needed. Close fetal monitoring is also recommended during pregnancy.
GDM
Gestational diabetes is glucose intolerance first recognized during pregnancy. It occurs due to placental hormones causing insulin resistance. Risk factors include obesity, family history of diabetes, and advanced maternal age. It is screened for and diagnosed using a 75g oral glucose tolerance test. Treatment involves lifestyle modifications like diet and exercise as well as insulin therapy if needed. Close monitoring of blood glucose and fetal well-being is required. Management aims to prevent complications in both mother and baby.
Nguyen thy khue
This document discusses diabetes and pregnancy, focusing on gestational diabetes (GDM). It provides information on:
1) The pathophysiology and risk factors of GDM, noting that it is characterized by increased insulin resistance and inadequate insulin secretion as pregnancy progresses.
2) Findings from the Hyperglycemia and Adverse Pregnancy Outcomes (HAPO) study that showed associations between higher maternal glucose levels and increased risk of adverse pregnancy outcomes.
3) International recommendations and criteria for screening and diagnosing GDM, which vary between organizations like ADA, IADPSG, and WHO. Regular screening is recommended between 24-28 weeks gestation.
GESTATIONAL DIABETES MELLITUS
Gestational diabetes can cause complications for both the mother and baby if not properly managed. It is important to monitor blood sugar levels and control glucose through diet, exercise and possibly medication like insulin. Maintaining near-normal blood sugar can help prevent issues like macrosomia, birth injuries, and future diabetes. Treatment aims to control glucose and reduce risks through regular monitoring, medical nutrition therapy, and starting insulin if needed to protect maternal and fetal health.
Gestational Diabetes Mellitus.pptx
Gestational diabetes mellitus (GDM) is a type of diabetes diagnosed during pregnancy that causes high blood sugar levels. GDM is usually diagnosed between 24-28 weeks of pregnancy through a glucose screening test and can increase the risk of complications for both mother and baby. Women with GDM may need to monitor their blood sugar levels closely and manage the condition through medical nutrition therapy, exercise, oral medications, or insulin to control blood sugar and minimize risks. Proper management of GDM can help lead to healthy outcomes for both mother and baby.
The Primary Care Physician's guide to management of Pregnancy Diabetes
A guide on the screening, diagnosis and management of diabetes in pregnancy aimed at facilitating the handling of this condition in a primary care setting. Includes details on medications and dosages
GDM.pptx
This document discusses gestational diabetes mellitus (GDM), including its definition, types, risk factors, screening recommendations, and pathophysiology. GDM is a type of diabetes that develops during pregnancy and usually resolves after giving birth. However, women with GDM and their babies are at higher risk for developing type 2 diabetes later in life. The document recommends screening all pregnant women for GDM between 24-28 weeks of gestation using a 75g oral glucose tolerance test. A diagnosis of GDM is made if one plasma glucose value meets or exceeds the threshold.
Gestational diabetes mellitus(gdm)
Gestational diabetes mellitus (GDM) is a type of diabetes that is first recognized during pregnancy. An oral glucose tolerance test is used to diagnose GDM, with abnormal fasting or post-meal blood glucose levels indicating GDM. Women with GDM are at higher risk of complications during pregnancy like preeclampsia and delivering a large baby, so treatment focuses on maintaining normal blood glucose levels through diet, exercise, and possibly insulin or metformin. After delivery, women with GDM have an increased long-term risk of type 2 diabetes and should undergo screening.
Gestational Diabetes Mellitus
Gestational diabetes (GDM) occurs when a woman without diabetes develops high blood sugar levels during pregnancy. It is caused by hormones from the placenta that interfere with the mother's insulin and metabolism. GDM affects approximately 10% of pregnancies and screening involves a glucose challenge test followed by an oral glucose tolerance test if high blood sugar levels are detected. Untreated GDM can lead to complications for both mother and baby such as preeclampsia, macrosomia, and jaundice. Treatment focuses on medical nutrition therapy, exercise, blood sugar monitoring, and possibly insulin to control glucose levels and minimize risks.
Gestational Diabetes Mellitus - DevanRaj
Gestational diabetes (GDM) occurs when a woman without diabetes develops high blood sugar levels during pregnancy. It is caused by hormones from the placenta that interfere with the mother's insulin and metabolism. GDM affects approximately 10% of pregnancies and screening involves a glucose challenge test followed by an oral glucose tolerance test if levels are high. Untreated GDM can lead to complications for both mother and baby such as preeclampsia, macrosomia, and jaundice. Treatment focuses on medical nutrition therapy, glucose monitoring, and possibly insulin to control blood sugar and minimize risks.
Gestational diabetes mellitus
This document provides information on gestational diabetes mellitus (GDM), including its definition, risk factors, pathophysiology, screening methods, complications, and management. GDM is glucose intolerance that develops during pregnancy and can cause issues for both the mother and baby if not properly managed. The key aspects discussed are:
- GDM is caused by defects in insulin secretion/action leading to abnormal carbohydrate and lipid metabolism.
- Risk factors include family history of diabetes, previous large baby, and obesity.
- Screening typically occurs between 24-28 weeks using a 75g oral glucose tolerance test.
- Complications for the mother include preeclampsia and operative delivery, while risks for
Diabetes+and+Pregnancy
Gestational diabetes affects 2-3% of pregnancies and is characterized by carbohydrate intolerance that develops during pregnancy. Risk factors include maternal age over 25, family history of diabetes, prior macrosomia or stillbirth. Screening involves a glucose challenge test at 24-28 weeks of gestation. A diagnosis requires two abnormal values on a 3-hour oral glucose tolerance test. Treatment focuses on tight glycemic control through diet, exercise and possibly insulin to reduce risks of complications for both mother and baby like macrosomia, birth trauma and neonatal hypoglycemia.
Diabetes&pregnancy
This document discusses pregnancy and diabetes. It notes that the prevalence of diabetes among pregnant women is rising. Pregnancy causes insulin resistance and hormonal changes that can lead to gestational diabetes if the pancreas cannot keep up. Good control of blood sugar levels is important for the health of both the mother and baby by avoiding complications like macrosomia. Screening and treatment involve monitoring blood sugar, medical nutrition therapy, exercise, and potentially insulin treatment. Close monitoring is needed throughout pregnancy and delivery.
Diabetes In Pregnancy[1]
Gestational diabetes affects 2-3% of pregnancies and is characterized by carbohydrate intolerance that is first diagnosed during pregnancy. It increases the risk of complications for both mother and baby, such as preeclampsia, operative delivery, macrosomia, and neonatal hypoglycemia. Treatment involves diet, exercise, and possibly insulin therapy to maintain normal blood glucose levels and minimize risks. Close monitoring of blood glucose and fetal growth is important throughout the pregnancy and delivery.
gestationaldiabetes-200902111122.pdf
This document discusses gestational diabetes mellitus (GDM), including its definition, epidemiology, etiology, pathophysiology, risk factors, maternal and fetal complications, screening, medical management, and the role of physiotherapy. Some key points:
- GDM is defined as glucose intolerance that begins or is first recognized during pregnancy and resolves after delivery.
- It occurs in 7% of pregnancies and risk increases with age over 35.
- Pregnancy causes insulin resistance which can lead to GDM if not met with adequate insulin production.
- Complications for the mother include preeclampsia and future type 2 diabetes; complications for the baby include macrosomia, hypoglycemia
Diabetes in pregnancy
This document describes the case of a 41-year-old woman, Iman, who is 13 weeks pregnant with her tenth pregnancy. She has a history of gestational diabetes in previous pregnancies and is currently being treated for diabetes with insulin. She presented with high fasting blood glucose and symptoms of polydipsia, polyphagia, and mood lability. Her pregnancy is considered high risk due to her history of gestational diabetes and previous complications. She is being monitored closely and managed according to guidelines for gestational diabetes.
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The Primary Care Physician's guide to management of Pregnancy Diabetes
The Primary Care Physician's guide to management of Pregnancy Diabetes
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Gestational diabetes
Gestational diabetes (GDM) is glucose intolerance first identified during pregnancy. Risk factors include BMI over 30, previous large or diabetic baby, family history of diabetes. GDM is identified through a 75g oral glucose tolerance test. It is associated with risks like large baby, shoulder dystocia, preeclampsia. Treatment like insulin lowers risks. Other types of diabetes may present as GDM and require identification. Mild maternal hyperglycemia increases risks incrementally without a clear threshold.
Endocrine disease in pregnancy
This document discusses the management of various endocrine diseases in pregnancy, including hypothyroidism, hyperthyroidism, prolactinoma, and Addison's disease. It provides guidance on treatment, monitoring, risks of under-treatment, and complications for each condition. Case examples are presented and management strategies are outlined, emphasizing the importance of optimizing treatment to reduce risks while minimizing harm to the mother and fetus. Close monitoring is recommended for conditions like Graves' disease and prolactinoma.
Diabetes in pregnancy
This document discusses diabetes in pregnancy, including:
- Risks to the mother include acceleration of complications like eye and kidney disease, as well as risks of hypoglycemia, pre-eclampsia, and obstetric complications.
- Risks to the fetus include congenital malformations, macrosomia, stillbirth, neonatal death, and issues like hypoglycemia and jaundice after birth.
- Management involves tight glycemic control, aspirin, monitoring for complications, and delivery planning based on gestational age and fetal growth. Acute issues like hypoglycemia and diabetic ketoacidosis require prompt treatment.
Hypoglycaemia in older people
- Hypoglycemia is more common in older adults treated with insulin or sulphonylureas and can be difficult to recognize due to non-specific symptoms. Unexplained falls, unsteadiness, or nausea may indicate unrecognized hypoglycemia.
- Maintaining tight glycemic control with aggressive HbA1c targets increases hypoglycemia risk in older adults. Guidelines recommend less stringent HbA1c targets for older patients based on functional status and comorbidities.
- Glucose variability in addition to average blood sugar levels affects hypoglycemia risk. Measuring endogenous insulin levels may help identify patients at risk of hypoglycemia due to absolute insulin deficiency.
Diabetes in the elderly
This document discusses diabetes management in the elderly population. It highlights that life expectancy is lower for those with type 1 diabetes compared to those without. A study on elderly patients who received awards for long-term diabetes found identifiers of long survival included reasonable blood sugar control, normal weight, and being non-smokers. Guidelines recommend individualized care plans for elderly patients in care homes that are agreed upon by the patient, doctor, and home staff. An audit found that some care home staff lacked diabetes education and homes did not always have policies for treating low blood sugar. Management of diabetes in the elderly aims to avoid low blood sugar, control symptoms, and reduce risks of infection and hospitalization.
Primary hyperaldosteronism - arterial venous sampling cases
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This document summarizes the key components involved in vitamin D and calcium homeostasis, including the roles of vitamin D, parathyroid hormone (PTH), and calcitonin. It discusses how vitamin D is obtained from sunlight or diet and activated in the body. PTH and calcitonin work in opposition to regulate calcium levels - PTH increases calcium levels by acting on the kidneys and bone, while calcitonin decreases calcium levels by inhibiting bone resorption. PTH and vitamin D also interact, as vitamin D helps absorb calcium from the gut and PTH stimulates its production. Together this maintains appropriate calcium and phosphate levels in the blood and body.
Calcium metabolism handout
This document discusses calcium homeostasis and disorders, including hypercalcemia and hyperparathyroidism. It provides details on the roles of parathyroid hormone (PTH), vitamin D, and calcitonin in regulating calcium levels. It examines causes of hypercalcemia such as primary hyperparathyroidism, malignancy, and vitamin D toxicity. Guidelines for treatment of asymptomatic primary hyperparathyroidism with surgery or medication are reviewed based on calcium levels, bone mineral density, kidney stones, and age. Non-surgical treatments including vitamin D supplementation and cinacalcet are also discussed.
Kallmann syndrome
The document discusses delayed puberty, defined as the absence or incomplete development of secondary sex characteristics past a certain age. It then focuses on hypogonadotrophic hypogonadism, which affects about 1 in 10,000 male births and can be associated with loss of smell. Sixteen gene defects have been linked to Kallmann syndrome. Short term goals of treatment include attaining appropriate sexual development and growth, while long term goals include maintaining normal hormone levels and inducing fertility. Pretreatment with FSH before GnRH therapy has shown promise in inducing testicular growth and fertility in men with congenital hypogonadotropic hypogonadism and underdeveloped testes.
Kallmann syndrome
The document discusses delayed puberty, defined as the absence or incomplete development of secondary sex characteristics past a certain age. It then focuses on hypogonadotrophic hypogonadism, which affects about 1 in 10,000 male births and can be associated with loss of smell. Sixteen gene defects have been linked to Kallmann syndrome. Short term goals of treatment include attaining appropriate sexual development and growth, while long term goals include maintaining normal hormone levels and inducing fertility. Pretreatment with FSH before GnRH therapy has shown promise in inducing testicular growth and fertility in men with congenital hypogonadotropic hypogonadism and underdeveloped testes.
Hypogonadism and testosterone replacement part 2
The FDA is investigating the risks of stroke, heart attack, and death in men taking testosterone products due to two recent studies suggesting increased cardiovascular risks. While the FDA has not concluded testosterone treatment definitively increases these risks, they are reassessing the safety issue. The FDA advises patients to discuss concerns with their healthcare providers and for providers to consider if benefits outweigh potential risks. Testosterone is only approved to treat medical conditions causing low levels like testicular or hypothalamic-pituitary problems.
Hypogonadism and testosterone replacement
This document discusses hypogonadism and testosterone replacement. It provides information on:
- The causes and clinical presentation of primary and secondary hypogonadism.
- Diagnosing hypogonadism through patient history, physical exam, and measuring serum testosterone and other hormone levels.
- Goals of testosterone replacement therapy in treating symptoms and restoring physiological functions.
- Various treatment options for testosterone replacement therapy including oral, buccal, implant, patch, gel, and intramuscular injection formulations. It provides details on the administration and pharmacokinetics of these different options.
Erectile dysfunction in diabetes
Erectile dysfunction is common in men with diabetes and tends to be more severe than in non-diabetic men. Screening for ED should be conducted annually as part of diabetes reviews. Asking direct questions such as "Are your erections hard enough for penetration?" can help identify cases of ED. Phosphodiesterase type 5 inhibitors are usually first-line treatment but some men may require additional options or a dose change if initial treatment is not effective. Testosterone deficiency can also contribute to ED in diabetic men.
The role of the podiatrist
The podiatrist plays an important role in assessing risk and treating foot complications in patients with diabetes. Key responsibilities include performing vascular, neurological, and wound assessments; providing debridement and dressing of ulcers; addressing biomechanical issues; and ensuring proper offloading. The podiatrist works as part of a multidisciplinary team to educate patients, treat foot problems, and prevent amputations through a holistic approach to diabetic foot care.
The diabetic foot
This document discusses diabetic foot care and prevention of amputations. It notes that amputations due to diabetes account for significant NHS costs and resources. While up to 80% of amputations are preventable, amputation rates vary widely across the UK. The document examines factors contributing to high amputation rates in some areas like Devon, and opportunities to improve care through measures like the Ipswich Touch Test for inpatient foot screening and better coordination between primary and secondary care. Overall it emphasizes the importance of preventing foot complications in diabetes which can greatly reduce quality of life.
ADVANCE - Type 2 diabetes - vascular risk with intervention
This document summarizes a study that investigated the effects of intensive blood glucose control versus standard control in patients over age 55 with type 2 diabetes. Over 5 years of follow up, intensive control reduced the risk of major macrovascular and microvascular events by 10% compared to standard control. Intensive control also significantly reduced new or worsening nephropathy and new-onset microalbuminuria. However, it increased the risk of severe and minor hypoglycemia. The study found no difference in all-cause or cardiovascular mortality between the intensive and standard control groups.
DCCT/EDIC - Type 1 diabetes - cardiovascular risk with intervention
This document summarizes a study examining the effects of intensive versus conventional diabetes treatment on cardiovascular outcomes in patients with type 1 diabetes over 17 years of follow up. The study found that intensive diabetes treatment during the Diabetes Control and Complications Trial (DCCT) period resulted in lower HbA1c levels and was associated with a lower risk of cardiovascular events over the subsequent 17 years of follow up in the Epidemiology of Diabetes Interventions and Complications (EDIC) study, even as HbA1c levels between the groups converged during EDIC. The "metabolic memory" of intensive control during DCCT appeared to continue protecting against cardiovascular risk long term.
DCCT - Hypoglycemia
The DCCT trial compared intensive versus conventional diabetes treatment in 1,441 patients with type 1 diabetes from 1983 to 1989. The intensive group aimed for tighter blood glucose control through multiple daily insulin injections or pump therapy and frequent self-monitoring. This led to significantly more frequent hypoglycemic events compared to the conventional group, who followed a less strict regimen. Over the course of the trial, the intensive group experienced over 3 times as many hypoglycemic events and over 3 times the risk of hypoglycemic coma or seizure. However, intensive control also demonstrated long-term benefits in reducing diabetes complications.
DCCT overview
This document summarizes a randomized controlled trial that studied the effects of intensive versus conventional diabetes therapy in 1441 patients with type 1 diabetes between 1983-1989. The trial had two arms - a primary prevention arm of patients with diabetes for 1-5 years and no complications, and a secondary prevention arm of patients with diabetes for 1-15 years and some retinopathy or nephropathy. The intensive therapy group achieved significantly lower average blood glucose and HbA1c levels. In both prevention arms, intensive therapy reduced the risk of retinopathy, nephropathy, and neuropathy compared to conventional therapy, with risk reductions ranging from 34-76%. However, intensive therapy also led to higher rates of hypoglycemia.
DCCT – intensive diabetes therapy and glomerular filtration
The DCCT trial compared intensive diabetes therapy to conventional therapy in patients with type 1 diabetes over 22 years. Intensive therapy aimed to achieve an HbA1c level below 6.05% using three or more daily insulin injections or an insulin pump. Conventional therapy aimed to prevent symptoms of hyper/hypoglycemia with one-two daily injections. The trial found intensive therapy reduced the risk of impaired glomerular filtration rate (GFR) by 50% and end-stage renal disease by 50% compared to conventional therapy. Intensive therapy also slowed later GFR decline and increased mean GFR levels. The benefits were fully explained by lower HbA1c and albumin excretion from intensive therapy.
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- 1. Gestational Diabetes Yannis Dimitropoulos ST3 in Diabetes and Endocrinology Torbay Hospital Buckfast Abbey Diabetes and Endocrinology Training Day 07/05/2010
- 5. Deterioration of β cell function and insulin resistance in Type 2 diabetes 0 20 40 60 80 100 Age ß-cell function (%) – 10 –8 –6 –4 –2 0 2 4 6 – 12 30 40 50 60 70
- 6. Deterioration of β cell function and insulin resistance in Gestational DM 0 20 40 60 80 100 Age ß-cell function (%) – 10 –8 –6 –4 –2 0 2 4 6 – 12 30 40 50 60 70
- 7. Why is it important to treat Gestational Diabetes?
- 10. ACHOIS Results Outcome Intervention Routine Group Infants Number Number Total number 506 524 Birth weight 3335g 3482g Macrosomia (>4kg) 49 (10%) 110 (21%) Death (Neonatal/Stillbirth) 0 5 Stillbirth 0 3 Shoulder dystocia 7 16 Bone fracture 0 1 Nerve palsy 0 3 Jaundice 44 48
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Editor's Notes
- Type 2 diabetes is typically not diagnosed until Beta cell function has been significantly impaired. After diagnosis, beta cell function deteriorates linearly with time. Extrapolating back a graph of time vs. function from the UKPDS suggests that beta cell dysfunction begins many years before it results in a clinical presentation of type two diabetes.
- Type 2 diabetes is typically not diagnosed until Beta cell function has been significantly impaired. After diagnosis, beta cell function deteriorates linearly with time. Extrapolating back a graph of time vs. function from the UKPDS suggests that beta cell dysfunction begins many years before it results in a clinical presentation of type two diabetes.
- Women with at least one risk factor for GDM GTT 24-34 weeks – FPG <7.8 and 2-hr 7-8 - 11 1000 randomly assigned to ‘Intensive’ versus ‘Routine’ care ‘ Routine care’ – patients and physicians were not aware of the diagnosis of GDM
- 23,316 pregnant women at 15 centres in 9 countries with 75-g oral glucose-tolerance testing at 24 to 32 weeks of gestation. Blinded if fasting glucose <5.8 and 2-hour glucose <11.1 mmol/l
- Reviewed the evidence from HAPO, ACHOIS and all other available smaller randomized trials.
- NICE implies oral treatments as good as insulin.